Abstract
Intrauterine life is a critical period for the development of body fat and metabolic risk. This study investigated associations between birth weight and total and truncal body fat in adults. To do so, we analyzed data on 10,011 adults participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who self-reported birth weight as < 2.5kg, 2.5-4.0kg, or > 4.0kg at baseline (2008-2010) and underwent bioimpedance in the next follow-up visit (2012-2014). Greater mean total and truncal fat mass were seen in those with high birth weight compared with adequate birth weight (p < 0.001) in both sexes (total fat: 25.2 vs. 23.1kg in men and 31.4 vs. 27.7kg in women, and truncal fat: 13.5 vs. 12.4kg in men and 15.9 vs. 14.2kg in women). U-shaped patterns were observed in restricted cubic-spline analyses in the subset of 5,212 individuals reporting exact birth weights, although statistically significant only for those with high birth weight. In the whole sample, in comparing high to adequate birth weight, the latter predicted having a large (> 85 percentile) total and truncal fat mass, respectively: OR = 1.76, 95%CI: 1.37-2.25 (men) and OR = 1.86, 95%CI: 1.42-2.44 (women); OR = 1.68, 95% CI: 1.31-2.16 (men) and OR = 1.73, 95%CI: 1.31-2.28 (women). However, low birth weight predicted having a large (> 85 percentile) % truncal fat only in women (OR = 1.40, 95%CI: 1.03-1.91). In conclusion, in these men and women born in a period in which fetal malnutrition was prevalent, birth weight showed complex, frequently non-linear associations with adult body fat, highlighting the need for interventions to prevent low and high birth weight during pregnancy.
Highlights
Obesity, a major public health problem, is the world’s 6th most important risk factor for overall disease burden 1
Obesity results from a complex multifactorial process, which involves lifestyle and environmental exposures, social factors, socioeconomic conditions, family history and genetic factors 5
Weight gain is manifested throughout the course of life, and obesity risk begins early in life, with the intrauterine period being critical in its development [6,7,8]. Both low and high birth weight have been linked to greater risk of obesity in adulthood 9, as well as to obesity-related metabolic problems such as diabetes and hypertension 10
Summary
A major public health problem, is the world’s 6th most important risk factor for overall disease burden 1. It presents a high and growing prevalence in Brazil and the world 2, and causes hyperglycemia, hypertension, hypercholesterolemia, sleep apnea, and leads to type 2 diabetes, cardiovascular diseases, many cancers, chronic renal disease and a series of other conditions, including musculoskeletal ones, producing disease burden [1,3,4]. Weight gain is manifested throughout the course of life, and obesity risk begins early in life, with the intrauterine period being critical in its development [6,7,8] Both low and high birth weight have been linked to greater risk of obesity in adulthood 9, as well as to obesity-related metabolic problems such as diabetes and hypertension 10. There is compelling evidence that intrauterine adversity restricts fetal growth, and alters gene expression in a manner which favors increased future risk of adiposity and metabolic diseases [11,12]
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